What is Regenerative Medicine?

Regenerative medicine seeks to replace tissue or organs that have been damaged by disease, trauma, or congenital issues, vs. the current clinical strategy that focuses primarily on treating the symptoms. The tools used to realize these outcomes are tissue engineering, cellular therapies, and medical devices and artificial organs.

Combinations of these approaches can amplify our natural healing process in the places it is needed most, or take over the function of a permanently damaged organ. Regenerative medicine is a relatively new field that brings together experts in biology, chemistry, computer science, engineering, genetics, medicine, robotics, and other fields to find solutions to some of the most challenging medical problems faced by humankind.

When injured or invaded by disease, our bodies have the innate response to heal and defend. What if it was possible to harness the power of the body to heal and then accelerate it in a clinically relevant way? What if we could help the body heal better?

The promising field of Regenerative Medicine is working to restore structure and function of damaged tissues and organs. It is also working to create solutions for organs that become permanently damaged. The goal of this approach is to find a way to cure previously untreatable injuries and diseases.

What are stem cells?

Stem cells are cells that have the potential to develop into some or many different cell types in the body, depending on whether they are multipotent or pluripotent. Serving as a sort of repair system, they can theoretically divide without limit to replenish other cells for as long as the person or animal is still alive. When a stem cell divides, each “daughter” cell has the potential to either remain a stem cell or become another type of cell with a more specialized function, such as a muscle cell, a red blood cell, or a brain cell.

Regenerative Medicine & Stem-Cell Treatment

Many millions of adult stem cells are found in every human. Our body uses stem cells as one way of repairing itself. Studies have illustrated that if adult stem cells are harvested and then injected at the site of diseased or damaged tissue, reconstruction of the tissue is feasible under the right circumstances. These cells can be collected from blood, fat, bone marrow, dental pulp, skeletal muscle and other sources. Cord blood provides yet another source of adult stem cells. Scientists and clinicians are developing and refining their ability to prepare harvested stem cells to be injected into patients to repair diseased or damaged tissue.

How can stem cells treat disease?

When most people think about stem cells treating disease they think of a stem cell transplant.
In a stem cell transplant, embryonic stem cells are first specialized into the necessary adult cell type. Then, those mature cells replace tissue that is damaged by disease or injury. This type of treatment could be used to:

  • replace neurons damaged by spinal cord injury, stroke, Alzheimer’s disease, Parkinson’s disease or other neurological problems;
  • produce insulin that could treat people with diabetes and heart muscle cells that could repair damage after a heart attack; or
  • replace virtually any tissue or organ that is injured or diseased.

But embryonic stem cell-based therapies can do much more.

  • Studying how stem cells develop into heart muscle cells could provide clues about how we could induce heart muscle to repair itself after a heart attack.
  • The cells could be used to study disease, identify new drugs, or screen drugs for toxic side effects.

Any of these would have a significant impact on human health without transplanting a single cell.

What diseases could be treated by stem cell research?

In theory, there’s no limit to the types of diseases that could be treated with stem cell research. Given that researchers may be able to study all cell types via embryonic stem cells, they have the potential to make breakthroughs in any disease.

What cell therapies are available right now?

Many clinical trials for embryonic stem cell-based therapies have begun in recent years. Results from those won’t be available until the trials reveal that the therapies are safe and effective—which could take a few years.

While ten cell therapies have been approved around the world as of January 2016, the only widely used stem cell-based therapy is bone marrow transplantation. Blood-forming stem cells in the bone marrow were the first stem cells to be identified and were the first to be used in the clinic. This life-saving technique has helped thousands people worldwide who had been suffering from blood cancers, such as leukemia.
In addition to their current use in cancer treatments, research suggests that bone marrow transplants will be useful in treating autoimmune diseases and in helping people tolerate transplanted organs.

Other therapies based on adult stem cells are currently in clinical trials. Until those trials are complete we won’t know which type of stem cell is most effective in treating different diseases.

Platelet Rich Plasma

Platelets are circulating within our blood and bind together when they recognize damaged blood vessels. Platelets, the smallest of our blood cells, can only be seen under a microscope. They’re literally shaped like small plates in their non-active state. A blood vessel will send out a signal when it becomes damaged. When platelets receive that signal, they’ll respond by traveling to the area and transforming into their “active” formation.

A normal platelet count ranges from 150,000 to 450,000 platelets per microliter of blood. Sometimes referred to as autologous Platelet Rich Plasma (meaning using patient’s own blood). Blood typically contains 6% platelets whereas PRP has a significantly increased supra-physiological platelet concentration.

Platelet Rich Plasma (PRP) is a small volume of plasma, in which proteins, cytokines, red –and white blood cells, and concentrated platelet are suspended (4-7 times, when compared to native levels). Platelet level can vary depending on the method of extraction and equipment, studies have shown that clinical benefit can be obtained if the PRP used has an increased platelet concentration of 4x greater than normal blood

Normal blood contains around 150,000 to 450,000 platelets/microliter, therapeutic PRP should contain 1.0 million platelet/microliter.

When applied to a tissue, or injury sites, it induces tissue regeneration through multiple pathways, like platelet growth factor release and cell mediating cytokines.

Platelet must be activated at the level of tissue injury in order for the PRP graft to be successful.  During activation the platelet successfully releases their content and begins the healing cascade of events that leads to the restoration and growth of normal collagen. Wound healing or collagen repair can be separated into three separate phases or stages (inflammation, proliferation and remodeling).

For all PRP and Platelet Rich Plasma procedures, blood is required. Depending on the type of injury or location of the injury, the required whole blood amount could vary. It is important to have a final product that optimally provides the quickest and most complete healing cascade. Processing of PRP into either leukocyte poor or leukocyte rich PRP is mandatory by many doctors.  Other white blood cells and components of blood have different healing qualities. As we learn more about these protocols and results, RMTI’s PRP courses will continue to evolve with the information we collect.

Bone Marrow Aspirate Concentrate (BMAC)

Bone Marrow Aspirate Stem Cell Concentrate (BMAC) is a component of your bone marrow that contains growth factors and anti-inflammatory proteins which have been shown to promote bone and soft tissue healing as well as reduce symptoms of pain related to injuries, tendinitis and arthritis.

Stem cells can be found in many tissues throughout your body, but one of the richest sources can be found in your bone marrow. Bone Marrow Concentrate (BMC) Therapy, also known as Bone Marrow Aspirate Concentrate (BMAC) Therapy, is a promising cutting-edge regenerative therapy to help accelerate healing in moderate to severe osteoarthritis and tendon injuries.

BMAC therapy is a promising non-surgical regenerative treatment used to treat various orthopedic injuries, including moderate to severe osteoarthritis and tendon injures. BMAC is a concentrate of regenerative stem cells obtained from a patient’s own bone marrow.

The physician removes a small amount of the patient’s bone marrow and spins it in a centrifuge in order to generate a powerful concentrate that is injected into the injured area. In the past, these types of cells were often very difficult and expensive to obtain from the body. With recent medical advancements, the cells can be easily obtained and the procedure can be done with minimal discomfort by a simple office procedure.

You can learn more about Platelet rich plasma in our Global Regenerative Academy! Subscribe here.

Bone Marrow

Bone marrow cells reside deep inside bone cavities in the most protected part of the body and are redundant throughout the organism. This preferential status reflects the primary role these cells play in the survival of the organism. Tissue repair is a dynamic self-organizing process that relies on cell mobility and growth factor production from cells within a biologic scaffold.

Platelets and Cells from Peripheral Blood Initiate the Inflammatory Process of the Healing Cascade and release cytokines to cause marrow cells to mobilize and home to the injury site (vasculogenesis).

Marrow stem cell and marrow complimentary cell mediated vasculogenesis and cell-to-cell contact with immune system stem cells transition the Healing Cascade from the inflammatory phase to the proliferation and remodeling phase. Concentrated Bone Marrow is designed to provide significant concentrations of CFU-F, CD34+, and total nucleated cell counts. CD34+ are cell markers for hematopoietic stem cells. These are the primary

multipotent cells that replenishes all blood cell types. These cells are crucial for the regenerative processes needed for active tissue repair. In addition to these cells are CFU-F, which are representative of mesenchymal stem cells. Mesenchymal stem cells (MSC) are multipotent stromal cells that can differentiate into a variety of cell types, including cartilage, bone and adipose cells. BMC provides therapeutic concentrations of these cell types which is the key to desirable patient outcomes.

Adipose

Adipose is used in regenerative medicine procedures because mesenchymal stem cells can be isolated from almost every tissue in the human body.  The central connecting aspect to explain this fact is that all of these tissues are vascularized and that every blood vessel in the body has mesenchymal cells in abluminal locations. These perivascular cells can be summarily called Pericytes.

Adipose-Derived MSCs are being used therapeutically because they undergo homing to sites of inflammation or tissue injury and they secrete massive levels of bioactive agents that are both immunomodulatory and trophic.

Stem Cells

Stem cells are generally defined as undifferentiated cells that are capable of self-renewal through replication and cells that undergo differentiation into specific cell lineages. Adult stem cells are necessary to maintain tissue and organ mass during normal cellular turnover. Adult stem cells are found in many tissues. There are undifferentiated cells and differentiated cells in tissue samples. The primary role of stem cells is to maintain and repair the tissue in which they are found. Most Adult Stem Cells are multipotent, not pluripotent. Pluripotent: can differentiate into any cell type. Multipotent: can differentiate into a subset of cell types. Adult stem cells may exhibit plasticity. Our stem cell training courses are designed for you to understand these intricate details about ortho-biologics and regenerative medicine.

Hematopoietic Stem Cells

Another type of stem cell we are using is called a hematopoietic stem cell (HSCs). These are stem cells that are found circulating in the blood, fat, and the bone marrow. They produce blood cells (white blood cells, red blood cells etc.), blood vessels, and also help guide tissue regeneration. Think of the blood vessels as a supply line and stem cells as an army. An army will cease to exist without a supply line. We utilize the HSCs in helping to direct other cells to help accomplish repair. It is these cells that drive tissue regeneration. These cells can also morph into other types of cells. This process is called plasticity. These hematopoietic stem cells are the true workers. In scientific circles these cells are many times called CD 34+ stem cells. This name (CD34+) refers to a marker on the cell surface. The definition of hematopoietic stem cells has undergone considerable revision in the last two decades. The hematopoietic tissue contains cells which have long-term and short-term regeneration capacities. These cells reside in the stem cell niche in the bone marrow.

Mesenchymal Stem Cells

Originally, Mesenchymal Stem Cells (MSCs) were thought to be the drivers of tissue regeneration. We now know that this is not quite accurate. MSCs will dramatically reduce (immuno-modulate) the inflammation in an area affected by an orthopedic disorder. When the inflammation is reduced, repair can take place. The mesenchymal stem cell is a cell that has many tasks but one of its main tasks is to act as an immune modulator. An immune modulator is a cell that reduces the inflammatory response in the body. Perhaps a good analogy to give to a mesenchymal stem cell is to liken it to a Navy Seal. Like a Navy Seal the mesenchymal stem cells are very specialized, parachuted (injected) into a hostile area, and probably will not survive. Their task is to secure the area so that other cells can accomplish their job. They have made the environment much less hostile for other regenerative cells. Mesenchymal stem cells are very plentiful in adipose (fat) tissue but are not as plentiful in bone marrow. When we use fat tissue as a source of Mesenchymal Stem Cells, we do not break the fat tissue down with an enzyme. We feel the best way to utilize the fat is as a free fat graft. One hidden gem in a free fat graft is a special type of cell called a MUSE cell. A Muse Cell does well under stress and more importantly it is considered a pluripotent cell. This means it can form almost any type of tissue. It is most likely found in all free fat grafts.

Adipose Stromal Vascular Faction (SVF)

Adipose tissue has emerged as an attractive cell source in tissue engineering and regenerative medicine because it can be easily collected and enriched with stem/progenitor cell populations. The stromal vascular fraction (SVF) derived from adipose tissue contains heterogeneous cell populations such as mesenchymal progenitor/stem cells, preadipocytes, endothelial cells, pericytes, T cells, and M2 macrophages. SVF-derived mesenchymal progenitor/stem cells can be easily expanded in vitro and have the potential to create diverse lineages of cells. Although there have been issues related to their isolation and purification, SVF cells demonstrate regenerative potential in damaged tissues or organs through paracrine and differentiation mechanisms. Furthermore, SVF cells augment immunological tolerance by promoting inhibitory macrophages and T regulatory cells and by decreasing ongoing inflammation. Numerous implantations of freshly isolated, autologous adipose tissue-derived SVF cells in cosmetic surgeries and in a wide variety of other specialties support the safety of SVF cells and have accelerated their clinical application. Despite these attractive advantages of SVF cells in clinical interventions, to our knowledge the recent status of clinical studies of various diseases has not been fully investigated.

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